Division of Pediatric Cardiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Int J Cardiol. 2008 Oct 13;129(3):333-8. doi: 10.1016/j.ijcard.2007.08.084. Epub 2007 Dec 21.
Pulmonary hypertensive crisis (PHC) is a significant contributor to the morbidity and mortality of surgery for congenital heart defect. Management of such a potentially fatal complication has been evolving for the past decades. Inhaled iloprost has been reported as an alternative treatment for this condition. We evaluated the use of aerosolized iloprost as a rescue therapy for PHC in children undergoing congenital heart surgery.
In this clinical study, 12 high risk children were monitored in order to identify postoperative PHC after congenital heart repair. Factors being monitored included pulmonary artery pressure, systemic blood pressure, left atrial pressure, transcutaneous oximetry and heart rate. PHC was defined as an acute rise in pulmonary pressure which causes cardiopulmonary compromise as reflected by desaturation and hypotension. Despite conventional medical treatment to prevent postoperative PHC, children with PHC were therefore administered with aerosolized iloprost (0.5 microg/kg).
Eight of the 12 children had one or more episodes of PHC, secondary to the pulmonary vasoreactivity. All responded to the aerosolized iloprost treatment, as demonstrated by a fall in their mean pulmonary pressure from 47.9 + or - 14.9 to 30.2 + or - 7.9 mmHg (p=0.012) and a rise in the arterial saturation from 82.2 + or - 16.7 to 93.4 + or - 11.5 % (p=0.012) while mean systemic blood pressure tended to increase from 59.4 + or - 12.1 to 64 + or - 10.3 mmHg (p=0.16).
In medical setting with limited access to the nitric oxide, inhaled iloprost is consider to be an effective alternative treatment for postoperative PHC in children undergoing congenital heart surgery.
肺动脉高压危象（PHC）是先天性心脏病手术发病率和死亡率的重要原因。过去几十年来，这种潜在致命并发症的治疗方法一直在不断发展。吸入伊洛前列素已被报道可作为治疗这种疾病的替代方法。我们评估了雾化伊洛前列素作为先天性心脏手术后发生 PHC 的儿童的抢救治疗。
在这项临床研究中，监测了 12 名高危儿童，以确定先天性心脏修复后的术后 PHC。监测的因素包括肺动脉压、体循环血压、左心房压、经皮血氧饱和度和心率。PHC 被定义为肺动脉压急性升高，导致心肺功能受损，表现为低氧血症和低血压。尽管采取了常规药物治疗以预防术后 PHC，但仍对患有 PHC 的儿童给予雾化伊洛前列素（0.5 μg/kg）。
12 名儿童中有 8 名或更多名儿童发生了 1 次或多次 PHC，这是由于肺血管反应性所致。所有儿童均对雾化伊洛前列素治疗有反应，其平均肺动脉压从 47.9 ± 14.9 降至 30.2 ± 7.9mmHg（p=0.012），动脉血氧饱和度从 82.2 ± 16.7%升至 93.4 ± 11.5%（p=0.012），而平均体循环血压则从 59.4 ± 12.1mmHg 升高至 64 ± 10.3mmHg（p=0.16）。
在一氧化氮获取有限的医疗环境下，吸入伊洛前列素被认为是先天性心脏手术儿童术后 PHC 的有效替代治疗方法。
